Healthcare Provider Details

I. General information

NPI: 1942164587
Provider Name (Legal Business Name): HAILEY'S WAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 GLENOAKS BLVD
SAN FERNANDO CA
91340-1624
US

IV. Provider business mailing address

18039 CHATSWORTH ST UNIT 3241
GRANADA HILLS CA
91344-5608
US

V. Phone/Fax

Practice location:
  • Phone: 818-277-1333
  • Fax:
Mailing address:
  • Phone: 818-277-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SMITH III
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 818-277-1333